ABSTRACT
Background: Consuming the carbohydrate-rich portion of meals after vegetables and proteins (CHO-last food order) reduces postprandial glucose and insulin excursions in patients with prediabetes/diabetes compared to the reverse order (CHO-first food order). We implemented a 16-week behavioral intervention to assess the impact of CHO-last food order on body weight and nutrient intake in prediabetes context. Methods: Adults with BMI>25 and HbA1c 5.7-6.4% were randomized to receive standard nutritional counseling (C) or standard nutritional counseling + CHO-last food order counseling (FO). All subjects received 4 monthly counseling sessions and kept exercise (E) stable for 16 wks. Body weight and diet from 3-day food records were assessed at wks 0 and 16. Due to the pandemic, later participants received some or all their counseling via telemedicine. Results: Of 45 randomized subjects, 39 completed the study (C=21, FO=18). Demographics and wk 0 variables (e.g. weight, HbA1c, and caloric intake) were similar in C and FO, except fiber intake (C 24.9 ±10.6 g vs. FO 18.3±6.4 g, p=0.028). E was similar in C and FO at wks 0 and 16. Body weight declined significantly in the FO group (-3.6 ±5.7 lbs, p=0.017;-1.8% ±2.8, p=0.012) and changed for the C group (-2.6 ±6.8 lbs, p=0.102;-1.6% ±3.5, p=0.048), with statistically similar weight change between groups. At wk 16, only C group reduced daily intake of calories (-292.2±505.9 kcal, p=0.016), fat (-13.0±25.4 g, p=0.029), protein (-15.0±26.3 g, p=0.017), and grains (-1.0 ±1.9 oz-equivalents, p=0.027). FO increased daily intake of vegetables (1.0 ±1.6 cups, p=0.019) and protein (2.5±5.1 oz-eq, p=0.05). There was a significant change in protein intake (FO 10.0 ±34.3 g vs. C -15.0 ±26.3 g, p=0.014). Sensitivity analysis of pre-COVID participants showed greater weight loss in FO vs. C (-5.9 ±5.3 lbs, p=0.003;-1.0 ±6.8 lbs, p=0.608). Conclusions: CHO-last food order behavioral counseling led to greater vegetable and protein intake and favorable weight change. Food order can be a useful strategy for weight management. Further study is needed to discern its clinical impact.